Background: Hepatocellular carcinoma [HCC] is the second leading cause ofcancer death worldwide. For HCC diagnosed at early stages, curative treatmentby liver resection [LR] achieves a 5-year overall survival [OS] of 50–70%. HCCsdeveloping in non-cirrhotic liver or as a solitary tumor in compensated cirrhosisare ideal targets for LR. However, optimal pre-operative assessment of HCCpatients and prediction of their outcomes are challenging. We analyzeddemographic, laboratory, and radiological characteristics of resected HCCpatients and investigated the effects of inflammatory and nutritional markers onlong-term outcomesMethods: We included 355 patients with HCC who received LR as primarytreatment at Mayo Clinic between April 1995 and July 2018 after obtaining properresearch authorization. Baseline demographic, clinical, laboratory and radiologicdata were analyzed to assess their prognostic effects on OS defined as the timefrom resection to death or last contact, disease-free survival [DFS] defined as thetime from resection to recurrence or death, whichever occurred first, andsurvival after recurrence [SAR], defined as the time from recurrence to death orlast contact. OS, DFS, and SAR were estimated by Kaplan Meier methods andcompared using log-rank tests. Factors determining OS, DFS and SAR wereidentified by multivariate analysis
Results: Higher pre-operative lymphocyte monocyte ratio [LMR] was significantlyassociated with better OS. For patients with LMR > 2.63 vs. LMR <= 2.63), 1-year[yr], 5-yr and 10-yr OS were 93.6% vs 79%, 65.7% vs 36.6%, and 42.4% vs 21.7%,
respectively (p<0.001). Similarly, higher prognostic nutritional index [PNI] wassignificantly associated with better OS. For patients PNI > 42.00 vs. PNI <= 42.00 ,1-yr, 5-yr, and 10-yr OS were 95.3% vs 76.5%, 63.7% vs 39%, and 43.5% vs 17.9%,respectively (p<0.001). In multivariate analysis of OS, LMR (Hazard ratio[HR]=0.69, 95% confidence interval [CI] 0.54–0.89, p=0.004) and Child Pugh score(HR=4.33, 95%CI 1.68–11.14, p=0.002) were significant prognostic factors. ForDFS, LMR [HR=0.76, 95%CI 0.63-0.93, p=0.007] had significant prognostic effect.Finally, neutrophil to lymphocyte ratio [NLR] (HR=1.001, 95%CI 1.0-1.002,p=0.005) was significantly associated with SAR, though patients with high LMRand PNI had prolonged SAR compared to patients with low LMR and PNI
Conclusion: Pre-operative systemic inflammatory and nutritional markersrepresented by LMR and PNI are significantly associated with outcomes followingLR for HCC